delegate registration form - Safety Services New Brunswick
delegate registration form - Safety Services New Brunswick
delegate registration form - Safety Services New Brunswick
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DELEGATE REGISTRATION FORM<br />
Working Together to Build a Safe and Healthy <strong>New</strong> <strong>Brunswick</strong><br />
Register online at: www.ssnb.ca<br />
Name: ___________________________________________<br />
Company: ________________________________________<br />
Address: __________________________________________<br />
Dd<br />
Title: _____________________________________________<br />
<strong>Safety</strong> <strong>Services</strong> <strong>New</strong> <strong>Brunswick</strong> Member Non-Member<br />
City/Province: ______________________________________<br />
Postal Code: _______________________ Tel: ( ) _________________________ Fax: ( ) _______________________<br />
Email: __________________________________________________________ Registrations will be confirmed via email.<br />
Symposium Delegates: Please indicate which unchecked sessions (A or B) you plan to attend:<br />
Keynote – Changing <strong>Safety</strong> from a Priority to a Value Session 4A – Discover the Best Health & <strong>Safety</strong> Resources<br />
Session 1A – Valuing a Life<br />
Session 4B – Walk to Wellness<br />
Session 1B – Keeping Minds Healthy at Work<br />
Session 5 – If Injuries Don’t Matter… What Does?<br />
Session 2 – Symptoms and Management of Concussions Session 6 – Incivility in the Workplace<br />
Session 3A – Drug and Alcohol Policies in the Workplace Session 7 – Your Greatest Risk<br />
Session 3B – OHS Regulatory Change Update<br />
Keynote – Toward a Healthy Workplace<br />
Payment Method<br />
Cheque Enclosed<br />
Invoice Me (Payment due before Symposium)<br />
Charge my Credit Card (please check one):<br />
Visa MasterCard American Express <br />
Card # _________________________ Exp __________<br />
Name on Card: _________________________________<br />
Make Cheque Payable to:<br />
Price to Attend Symposium on <strong>Safety</strong><br />
<strong>Safety</strong> <strong>Services</strong> NB Member* $275<br />
Non-Member $375<br />
*If unsure contact <strong>Safety</strong> <strong>Services</strong> to determine if you are a<br />
member.<br />
Additional Meal Ticket for Spouse or Guest:<br />
One ticket is included with your <strong>delegate</strong> <strong>registration</strong>.<br />
Purchase ONLY if you are bringing a guest to lunch.<br />
<strong>Safety</strong> <strong>Services</strong> <strong>New</strong> <strong>Brunswick</strong><br />
440 Wilsey Road, Suite 204<br />
Fredericton, NB E3B 7G5<br />
To Register:<br />
___ Lunch Ticket(s) $40<br />
Total:<br />
(HST Included)<br />
$<br />
_______________<br />
$ ________________<br />
Toll Free: 1-877-762-7233 (7NBSAFE)<br />
Fax: (506) 444-0177 Email: info@safetyservicesnb.ca<br />
www.ssnb.ca<br />
For Hotel Reservations:<br />
Contact the Crowne Plaza Fredericton Lord Beaverbrook<br />
at 1-866-444-1946<br />
Quote Reference: <strong>Safety</strong> <strong>Services</strong> <strong>New</strong> <strong>Brunswick</strong>*<br />
Register Online<br />
You can register using a credit card online at:<br />
www.ssnb.ca<br />
Room Rate: $149.00/night plus tax<br />
*There are a limited number of rooms blocked, register early<br />
to avoid disappointment.<br />
Please let us know: How did you hear about our conference? Mailing Email Advertisement Employer Other
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